27 Oct First-Ever Cocaine Overdose Treatment in Clinical Trials
Cocaine is a powerfully addictive stimulant substance of abuse known for its ability to trigger non-fatal or fatal episodes of drug overdose. Such episodes are particularly difficult to predict and actually occur much more often than overdoses related to the opioid narcotic heroin. In a report published in September 2014, researchers from the University of Kentucky announced their progress on the development of a treatment for cocaine overdose. This treatment relies on modification of the natural chemical activity of an enzyme found in soil inhabited by the coca plant, which drug manufacturers use to make cocaine.
Illicit drug manufacturers use the coca plant to make two forms of cocaine: a powdered substance called cocaine hydrochloride and a modified, smokable form of this substance commonly known as “crack.” Both powdered cocaine and crack reach the brain relatively quickly, although the smoke from “crack” is faster acting than inhaled cocaine. Once inside the brain, both forms of the drug create a form of intense pleasure called euphoria and notably speed up the normal rate of electrochemical communication within the brain and spinal cord (the two components of the body’s central nervous system). Prominent consequences of this central nervous system speedup include a narrowing of the body’s blood vessels that triggers potentially steep increases in blood pressure, significant acceleration of the heart rate and spikes in the body’s baseline temperature. In addition to inhalation into the lungs and the nose’s mucous membranes, methods of introducing the drug include injection into a vein and oral consumption.
Cocaine overdoses occur when overstimulation of the central nervous system passes a sustainable point and key organs (especially the heart, blood vessels and lungs) stop functioning normally. However, unlike overdoses associated with heroin and other substances of abuse, overdoses associated with cocaine do not predictably stem from the consumption of certain amounts of the drug. In some cases, an affected individual may have consumed unusually large amounts of cocaine; however, overdoses also occur in users who consume much smaller quantities of the drug that don’t cause serious problems for most people. To make matters worse, experienced cocaine users may actually grow more sensitive to the drug’s toxic effects over time. This means that the unpredictable risk of overdose never fades away and may, in fact, increase for any individual.
The federal Substance Abuse and Mental Health Services Administration uses a system called the Drug Abuse Warning Network (DAWN) to track the number of people who require emergency treatment for cocaine use (and the use of all common substances of abuse) each year. In 2011 (the last year with fully reported figures), there were 505,224 cocaine-related emergency room visits across the U.S. No other substance, including alcohol and heroin, is responsible for sending so many people to an emergency department for medical care.
A New Potential Treatment
Cocaine overdoses are relatively short-lived, and many people survive their overdose episodes. However, a victim of an overdose can easily die from causes that include a stroke, a heart attack, cardiac arrest (complete heart stoppage), respiratory failure and severe seizures. Currently, doctors have no reliable way of intervening in cases of potentially fatal cocaine overdose.
The University of Kentucky researchers are conducting trials on humans designed to determine the effectiveness of an anti-overdose medication developed from an enzyme (a special type of protein) that naturally occurs where coca plants grow. The enzyme in question, called bacterial cocaine esterase, triggers a chemical reaction that essentially stops cocaine from producing its central nervous system-altering effects. Under normal circumstances, bacterial cocaine esterase does not last long enough in the human body to have any substantial effect. However, the University of Kentucky researchers have found a way to increase the durability of the enzyme and give it a lifespan long enough to disrupt cocaine’s drug actions. In addition to increasing bacterial cocaine esterase’s window of activity from a few minutes to roughly six hours, the researchers have used genetic manipulation to increase the enzyme’s potency by several thousand percent.
Currently, the clinical trials for the modified form of bacterial cocaine esterase are in their second phase. This means that the medication has shown effectiveness in small groups of people and is now suitable for testing in larger groups. The U.S. Food and Drug Administration requires an additional third phase of clinical testing before the medication can be marketed for public use.
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